HypertensionSecondary analysis
Intensive Blood Pressure Control in Older Patients With Hypertension
- Extended follow-up of the STEP randomised controlled trial
Authors' conclusion
Our results suggested that sustained intensive BP control could benefit patients with hypertension compared with delayed intensive treatment in the longer-term follow-up.
Study context
- Population
- Older patients with hypertension
- Participants
- 8,511 patients
- Comparison
- Sustained vs delayed intensive blood pressure (BP) treatment
- Primary endpoint
- Composite of:
- Stroke
- ACS
- Acute decompensated HF
- Coronary revascularization
- AF
- CV death
- Follow-up
- Median 6.11 years
Primary result
As reported in the abstract
Hazard ratio
0.82
95% CI 0.71–0.96
By group
Sustained intensive treatment
1.12% per year
Delayed intensive treatment
1.33% per year
Sustained intensive treatment vs Delayed intensive treatment
HR 0.82 (95% CI 0.71–0.96)
Further findings
Mean SBP · median follow-up 6.11 years
| Outcome | RR (95% CI) | |
|---|---|---|
| Primary outcome by timing of intensive treatment initiation vs standard BP treatment (parametric g-formula) — Intensive treatment from randomization (0 month) vs Standard BP treatment · greatest benefit | 0.83 (0.70–0.96) | |
| Primary outcome by timing of intensive treatment initiation vs standard BP treatment (parametric g-formula) — Intensive treatment from 12 months vs Standard BP treatment · attenuated benefit | 0.88 (0.76–0.99) | |
| 0.512Relative risk (log scale) |
Safety
Safety events
- No difference in safety event rates except hypotension, more frequent with sustained intensive treatment
Original publication
Intensive Blood Pressure Control in Older Patients With Hypertension. J Am Coll Cardiol. Published 17 October 2025. doi:10.1016/j.jacc.2025.06.045
Summarised from the published abstract; every number is checked against it